State turns down Macon hospice house as conflict with hospital continues

A group wanting to build a Hospice house in Macon County to serve the terminally ill in the westernmost counties says it will continue those efforts despite a recent thumb’s down from the state.

The N.C. Department of Health and Human Services said “no” to Hospice House Foundation of WNC’s request to build a six-bed hospice inpatient facility. New medical facilities — from hospitals to outpatient surgery centers — require state approval to move forward. The system supposedly prevents too much competition from undermining the financial viability of health care institutions.

But the closest comparable facility is two counties away in Haywood, where a six-bed Hospice house is under construction. The next closest is in Buncombe.

While there are no other hospice houses nearby, Angel Medical Center perceives such a facility as a competitor, claiming there is not enough demand to justify a stand-alone hospice and instead has plans to provide a hospice-like set-up within the hospital itself.

The hospice group has pledge to keep moving forward, however.

“Nothing has changed as far as our mission is concerned in providing this much needed facility for our hospice patients and their families in this part of Western North Carolina,” Michele Alderson, president of Hospice House Foundation, said via email to The Smoky Mountain News. “We are continuing in our fundraising.”

Chris Comeaux, president of Four Seasons Compassion for Life, a nonprofit Hospice group that has worked with the Macon County-based Hospice House Foundation on the project, said last week all options are being studied. Comeaux and Alderson have pointed out the state doesn’t always award a Certificate of Need on first application.

The state’s letter turning down the application noted an appeal could be filed with the N.C. Office of Administrative Hearings. Comeaux declined to outline specific strategy by the Hospice group, citing the legal proceedings.

Four Seasons, based in Henderson County, took over Highlands Hospice and Palliative Care from Highlands-Cashiers Hospital last year.

This triggered a less-than-happy reaction by Angel Medical Center in Franklin and ensuing controversy last year. The hospital administration cited conflict-of-interest concerns and severed ties with local Hospice volunteers who wanted to build the respite house. The hospital forced out five of its volunteers who also served on the hospice foundation, and demanded all of its 40 or so other volunteers sign confidentiality statements and conflict-of-interest disclosures.

Volunteers are the base of Hospice, which provides support for terminally ill patients and their families. Some caregivers sit with patients while family members run errands; others prepare meals or serve in various administrative roles for the organization.

Federal law requires that volunteers provide at least five percent of patient-care hours for institutions such as Angel Medical Center to receive Medicare and Medicaid reimbursement.

Angel Medical Center CEO Tim Hubbs has been direct about his beliefs that Four Seasons is a competitor in the local medical marketplace. Originally, plans called for Angel Medical Center and the Hospice House Foundation to build the house together, but the hospital pulled out of the project. To continue with its dream of a Hospice house, the foundation had to find another licensed operator to oversee the facility — and Four Seasons stepped up to fill that role.

Angel CEO Tim Hubbs said the hospital “believes the state made a good decision” in not giving the foundation a Certificate of Need.

He said the reasons provided by the state for disapproving the application were consistent with the concerns of Angel Medical Center. The state asserted Hospice House Foundation did not demonstrate adequate need, or the ability to raise the money needed to build the house.

“Plus we knew that many people that supported the Hospice House thought the house would provide residential and respite care for those patients without a caregiver, but the application filed did not include any residential beds and did not project any respite days of care,” Hubbs said.

He said Angel Medical Center has identified two additional patient rooms within the hospital and earmarked them “for enhancement” to meet the needs of hospice patients. The hospital, Hubbs said, will convert two adjacent rooms to help out caregivers and family members of the hospice patients.